How can I get BCBS to pay? - ThinnerTimes

SDeRossett · 04-15-2007, 05:27 AM

I'm almost five years out now and I have had the Abdominal Penniculectomy or how ever it's spelled where they remove the "Apron". What about the rest of me? #1 Breasts? I've gone to see a plastic surgeon and he said they could do breast reduction (BCBS will cover that) but I don't have enough left. He also said that I could have reconstruction but that BCBS dosen't cover it and I could pay for it myself for a mere 6-8 thousand dollars. (Includes everything - hospital, surgery, etc.) Yikes! I can't afford that! #2&3 What about the legs and arms? Has anyone had any luck with getting BCBS to cover those? How? Any input appreciated.

Sharon

lealphachienne · 04-15-2007, 12:38 PM

You have to have 3-4 months of doucmented complications with the excess skin...rashes, sores, or if the pannus gets in the way of mobility.

Gina in NY · 04-16-2007, 11:36 AM

Quote:

Originally Posted by SDeRossett

I'm almost five years out now and I have had the Abdominal Penniculectomy or how ever it's spelled where they remove the "Apron". What about the rest of me? #1 Breasts? I've gone to see a plastic surgeon and he said they could do breast reduction (BCBS will cover that) but I don't have enough left. He also said that I could have reconstruction but that BCBS dosen't cover it and I could pay for it myself for a mere 6-8 thousand dollars. (Includes everything - hospital, surgery, etc.) Yikes! I can't afford that! #2&3 What about the legs and arms? Has anyone had any luck with getting BCBS to cover those? How? Any input appreciated.

Sharon

My plastic surgeon gets he 85% of tummy tucks covered, but he says he has never gotten breast work covered except, as you say, reductions, but they have to remove one pound of tissue from each breast. If you wake up and it is any less, they don't pay. Nice, huh?

So boobs - you're on your own. Same with arms and legs. Unless you can't walk, can't perform regular activities like work etc. it isn't medically necessary and they won't cover it.

Sorry...but I thought it would be better to give you the info I have. Had to accept it myself.

SDeRossett · 04-16-2007, 04:33 PM

Thanks! I was hoping that maybe there was some sort of loop hole that I could qualify for. Anyone got the winning numbers to the lottery? Oh well, thanks again.

mauldinmama · 04-16-2007, 04:53 PM

LOL you know I can't answer the question...but I do know a friend of mine her breast were different sizes when she reached her goal and her insurance paid to have them 'taken care of??!!!!!"

hummingbird5953 · 04-16-2007, 07:50 PM

Quote:

Originally Posted by mauldinmama

LOL you know I can't answer the question...but I do know a friend of mine her breast were different sizes when she reached her goal and her insurance paid to have them 'taken care of??!!!!!"

Huh...never thought I'd hope to end up lopsided!

ladytonya · 05-26-2007, 12:14 PM

Wow! That's actually good to know as far as the breasts are concerned! I am 5 months, 2 weeks out and have lost 131 lbs. My boobs look awful! I started as a 56DDD and the latest bra I bought was a 44DDD. Band size has gone down but cups have not! As long as I keep that up, sounds like maybe I can get some boob work done. If they stay at DDD or even go down to D or DD, maybe I have hope. I know I'll need the apron removed and I'm hoping that they can at least do a little lift to take care of the legs some. I've heard that they do that sometimes. I can't afford to pay out of pocket for anything either so I understand where you're coming from, but I've got a long time before I consider doing anything. The day I'm 18 months out from surgery, I'm going to start trying to get pregnant so definitely nothing before a baby is born! Good luck to ya!

MiladyB · 05-26-2007, 09:17 PM

Well Sharon, I'm right along with you....trying to find a way for my insurance to cover the breasts. I don't have Blue Cross, I have Priority Health. They will cover a reduction but like Gina said, for me they would need to remove 800 grams. That's almost a pound per breast. I will be talking to my surgeon to see what he thinks...IF he thinks there is that much left. I highly doubt it. I'm still in a D-DD cup but most of it is skin which isn't as heavy as breast tissue. Still crossing my fingers though that I can find something. I could still maybe get it approved without having that much that needed to be removed but it means like ALOT of documentation from a physical therapist that my back pain is solely due to my breasts and nothing else. Also that I have tried physical therapy first for 6 months. We shall see, but I'm not holding out much hope...at least for this summer.

Zenomia · 05-26-2007, 10:17 PM

I have BCBS of Iowa, and I know each state has it's own regulations. Here, panni is covered for SOME circumstances. (Trying to get mine covered now), but the rest is considered cosmetic, no matter what! My SIL had to have a breast reduction to have some cystic masses removed from both breasts. You would have thought that would have been covered, but it wasn't. They fought it, but lost because the tissues were NOT life threatning. (Even though they could have posed future risks and she was a natural 34DD at 110#'s) I think it stinks...but they don't care what I think. Good luck trying to get them to cover...if you have any luck, let me know!! (I am having all of the things you mentioned done!!)

Starla · 05-29-2007, 04:25 PM

I have Kaiser Insurance and I cant get anything done. I look horrible (legs, arms) are the worst. I am stuck with what I have. I cant afford PS being a single provider for my elderly mother, 2 daughters (grown) and 7 grandchildren. Oh well at least the wrapped package looks good